Discovering aequanimitas and making your taper productive

Sir William Osler

Dr. William Osler

It has been said that “in patience ye shall win your souls,” and what is this patience but an equanimity which enables you to rise superior to the trials of life? Sowing as you shall do beside all waters, I can but wish that you may reap the promised blessing of quietness and of assurance forever, until within this life, though lifted o’er its strife, you may, in the growing winters, glean a little of that wisdom which is pure, peaceable, gentle, full of mercy and good fruits, without partiality and without hypocrisy.
– from “Aequanimitas”, by Dr. William Osler

In his essay, Aequaminitas, Dr. Osler references Antonius Pius, Emperor of Rome from 138 to 161 A.D. Pius was known for an unremarkable reign. Instead of continuously waging war, he built temples, theaters, and mausoleums, promoted the arts and sciences, and bestowed honors and salaries upon the teachers of rhetoric and philosophy. He was one of the world’s first true managers, addressing provincial matters by empowering their governors or local representatives rather then through the more common action of marching armies out of Rome to intimidate and bend will. Pius’ actions indicate that he clearly believed in the possibility of a lasting peace and valued the lives of his countrymen. On his death bed, he uttered the last word of his life, aequanimitas, and in doing so, he created a certainty of his life’s purpose.

Aequinimitas, a term introduced to me last May by Dr. Charles Wiener, Vice Chairman of Education at Johns Hopkins School of Medicine, and his team of doctors an nurses, means imperturbability, unshakably calm and collected. As it applies to the Johns Hopkins School of Medicine, it is described by Dr. William Osler as coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril. More importantly, it is a trait that is held as the premier quality of a good physician. It is also one of the most important qualities of an endurance athlete, and as the Race with Purpose team heads into its final week of preparation before the NYC Marathon, discovering this ability will be the most important activity.

A calm equanimity is the desirable attitude. How difficult to attain, yet how necessary, in success as in failure! Natural temperament has much to do with its development, but a clear knowledge of our relation to our fellow-creatures and to the work of life is also indispensable.
– from “Aequanimitas”, by Dr. William Osler

Dr. Osler continues his essay by making it clear that imperturbability is not something that everyone can master, but for those who can and do, they attain an appearance of confidence, experience and serenity. The process is not easy and requires one to expose themselves to extended periods of hardships and unexpected challenges on a recurring basis under mental, physical and emotional duress. It also requires a deep understanding of how we fit into a larger system. I can clearly see how this should apply to medical professionals and in some cases I’m certain it does. However, the visual that this initially evoked in me was one of Navy SEALs, or Army Rangers. These people are clear of purpose, quietly confident and on the surface quite unremarkable. They command rather than demand respect. These are also the traits of many elite endurance athletes. It’s not that anxiety or nervousness are missing, rather they have mastered the ability to harness that energy and refocus it onto the task at hand, refocus it with a calmness and coolness that becomes contagious to those around them.

As a coach, I have talked often of finding flow, a place where in the act of our choosing, we reach a level of engagement that is completely unselfconscious, removing us from our everyday worries and altering our sense of time. Race day is entirely about execution and the seamless adaptation to a dynamic environment. It is impossible to achieve flow if the mind is cluttered or distracted. Flow is therefore dependent upon imperturbability and together they optimize one’s ability to achieve a higher state of awareness and superior performance.

As endurance athletes, we may not stay up for days or weeks at a time, carry logs through the sand when both our mind and body are far past anyone’s perception of fatigue, or learn how to endure hypothermia, but we can clearly point to a consistent and systematic process of placing ourselves under duress over an extended period of time. Clearness of judgment in moments of grave peril is certainly something we all would demand from our doctors and from those who protect our country. It is also an attribute most competitive endurance athletes would choose to acquire.

The final period of training just prior to our race is called the taper. By its very name it sounds unremarkable. It is a period during which we convince ourselves that less active down time is necessary for our muscles to recover, our soft tissue to repair and during which fuel is allowed to accumulate for our upcoming event. In truth, for many, the taper is a frustrating, disturbing and unbelievably unsatisfying experience. After months of hard training, and with this stale and unpalatable after-taste we toe the start line expecting to perform at a superior level. Unfortunately, the taper has become the final part of training that even many experienced athletes simply don’t know how to make productive.

Previously, I’ve written about the benefits of making your taper more effective by maintaining your intensity while simply lessoning volume both in terms of overall time spent on training and the time and distance of individual workouts. I’ve also commented on the benefits of spending time on flexibility, core strength and visualization. Two articles that address this can be found on the Race with Purpose website: Tackling the Marathon Taper, and The Final Week of Taper. For those who have mastered the tactical recommendations in these articles, consider using this time to work on mastering what may be the toughest skill of all, aequanimitas.

In a true and perfect form, imperturbability is indissolubly associated with wide experience and an intimate knowledge of the varied aspects of disease. With such advantages he is so equipped that no eventuality can disturb the mental equilibrium of the physician; the possibilities are always manifest, and the course of action clear.
– from “Aequanimitas”, by Dr. William Osler

Presumably you have done the training and you have studied both the course and your competition. You have left nothing to chance. Continue this process by identifying previous times when you have acted with equanimity, when you have found evenness of mind under the most stressful of circumstances. Perhaps your experiences will come from your training; just as likely, you’ll find experiences from other parts of your life. Remember what it was that allowed you to maintain your focus, to stay calm under pressure and to act with objectivity and precision. The objective is to develop self confidence in your ability to draw upon this skill and to apply it consistently without exception.

Consider spending your taper week identifying what it is inside of you that gives you the strength to deliver unquestionably regardless of the conditions. I promise you that time spent doing this will leave you empowered and energized, not usually the adjectives used to describe a typical taper. Discover what it is inside of you that gives you the confidence to not only separate yourself from your competition, but to render it irrelevant. On race day, as you stand on the starting line waiting for the cannon to sound, recall the words of Dr. Osler and know that you will race with patience, calmness and serenity. In short you will find your flow and your course of action will be clear.

Wally comes home and gives me some additional inspiration

Wally recovering at home

Erin Strout, journalist extraordinaire and do-it-all for Race with Purpose reminds me not to bury the lead, so here it is. Last night Wally was discharged from the Animal Medical Center. After signing over the house for collateral, we carried Wally out in his carrier and back to the familiar surroundings of his home, you know the place where Henry and Little Girl and Wally all ignore each other.

Animals are amazing. Monday, Tuesday and Wednesday this cat was on death’s door. According to his vets, he was near dead. On Tuesday when Dr. Fox told us that his heart rate was at 260 beats per minute and it was expected that it would freeze and stop at any point and we were told that they would not try to resuscitate him, we were devastated and really had to stay focused and positive. It’s now Sunday and he is jumping on and off of the bed, hopping over fences and seems to be back to his normal self, albeit he has three sets of medication that he takes and we had to stay up last night counting his breathing to make sure it wasn’t becoming faster than expected – a sign that fluid was building up rapidly. We have to bring him in on Monday to get more fluid drained out of his lungs but all in all, I find it mazing that animals can bounce back so quickly, while a human would be laid up in bed either immobilized, completely fatigued or worse yet, mentally defeated. Animals just don’t seen to have that option. We can learn a lot from them.

Prepping my Cyfac bike which wouldn’t go into the big chain ring during the warm-up

So an update to the Cadence Kona Challenge. Again not to bury the lead, I was not selected as one of the 10 finalists. I did give it my best effort and felt I left it all out there. I have Wally to thank for that as I had his picture binder clipped to the stand in front of my bike and on the deck of the treadmill. I definitely dipped into that pool a number of times during the tests when I felt like crap.

Yeah, Coach Adam wins his wave with 270 Average Watts

I won my heat on the bike and ran pretty well on the treadmill with less than fresh legs, but apparently it wasn’t meant to be. It was a great experience, I got a lot of testing for free and the people were all incredibly supportive throughout the experience. At the end of the day, if the goal was to have 96 people leave the site feeling like they were all winners, even though we weren’t ultimately selected, Cadence and their sponsors (Zoot, Suunto, Cyfac, etc…) did just that.

Cindy and Bill living it up “W” style at Cadence Cycling Center

I have to give a shout out to Bill Porter from Suunto who was my own personal photojournalist/TriScoop heckler throughout the event and to Bill Risch and Cindy who came out to cheer me on. A great highlight was being able to interview and then run with Samantha McGlone who is the70.3 distance World Champion and who came in second just a few weeks ago at the Ironman World Chamionships in Kona. This was her first Ironman race, how crazy is that?

Coach Adam pulling watts on the bike

In case you are interested, and in the spirit of full disclosure, here are the results from my tests:

Bike

Functional Threshold Power = 257 watts (up from 225 in 2005)
Functional Threshold Heart Rate = 161 bmp (up from 146 in 2005)
Max Power = 340 watts (up from 300 watts in 2005)
Lactate Power to weight ratio of 3.02

Run

Functional Threshold Pace = 8 mph (down from 8.8 in 2005)
Functional Threshold Heart Rate = 165 bmp (down from 170 in 2005)

Weight = 187 lbs (up from 183 in 2005)

Resting Heart Rate = 48 (up from 42 in 2005)

So all in all, I’ve become a little more efficient and picked up a little power on the bike along with some additional weight – not exactly a good thing, and slowed down a bit on the run. I’m pretty pleased with this after spending the past two years focusing on everyone else’s training but my own. So it’s in writing, I’m looking to drop to 176 lbs and move my threshold power up to 275 by this summer. Given that I did the treadmill test right after the bike test, I’m alright with the numbers here, especially after popping off a 19:30 5K last weekend. The drop in weight will pull me under 40 minutes for a 10K this spring and give me a solid base to build from.

Performance amid distraction: The Wally Watch (Part 3)

Friday:

Cindy and I drove into the city this afternoon. According to Dr. Fox, Wally is improving slightly in terms of the fluid in his lungs, the fluid in his heart and his heart rate. That said, one of the four chambers of one of his lungs collapsed. Given everything else that could have happened thus far, his doctors felt that was manageable. Before I go any further, let me give you a little background on Dr. Fox, Wally’s surgeon.

Dr. Philip Fox with his patient

In case you’re thinking that I’m just some crackpot pet owner who’s just ebulliently thankful to the doctor who has helped to give our Wally the chance to live out the rest of his life, here are a few of Dr. Fox’s accomplishments:

Dr. Fox was one of the lead investigators studying the harm done on search and rescue animals involved at Ground Zero. He is a board certified cardiologist with more than 30 years experience and is the Director of AMC’s Caspary Research Institute. He has a long term relationship with the NYPD serving the needs of their canine officers. In short, he’s a rock star of vet. Cool with me and very cool with Wally.

Many years ago, my sister was playing football on the Santa Monica beaches in California. She laid herself prone to catch a pass and went face first into a volleyball standard, shattering the zygomatic arch and pulverizing the other bones around her eye in the process. Essentially, she turned her face into mush. The good news is that she was playing with some of her law enforcement friends and she was whisked away to nearby Daniel Freemon where there just happened to be one of the best surgeons in the world with repairing and reattaching nerves and rebuilding the structures supporting the eyes. He just happened to be lecturing there. He cut her skin on the top of her head, peeled it forward to gain access to her facial area and picked out the tiniest of bone fragments for hours, before molding bone from the back of her skull into a fake arch to support her eye.

Who knows if that was luck or if there was another reason that Stephanie injured herself on the day that he just happened to be in town lecturing at that particular hospital? Whatever it as, we were grateful and in that same way, we are grateful that Wally is being looked after by Dr. Fox. Even cooler because his name is also that of an animal.

Tomorrow, I’m scheduled to compete in a triathlon event called the Cadence Kona Challenge, an event sponsored by Cadence Cycling Center in NYC and Philadelphia that selected 100 people from across the country and Canada out of a group of 1500 to come to New York to test themselves by cycling and running. Based on the performance tomorrow, they’ll whittle the group down to a lucky 10 who will show up on Sunday to do more tests on the bike, treadmill and in an endless pool. Then a lucky 6 will go on to represent Cadence Cycling and a number of other very prominent sponsors as they train for Ironman 2008.

I appreciate the acknowledgment, and I definitely appreciate the swag, but based on what I saw this evening at a champagne-laden soirée for the semi-finalists, I have no business being in the same room with these folks. I’m going there to enjoy the experience, yes, but I’m also there to highlight the major impact that these adult athletes can make by helping to get kids healthy and active, supporting their ability to live long fruitful lives and positioning them as contributors rather than drainers of our healthcare system. The people in this room are from multiple generations and exemplify what it means to be healthy, balance priorities, extend oneself, and live life to the fullest.

There are clearly athletes with a lot more genetic ability, talent and recent training than me. I’ve never been genetically gifted and I’m a fast-twitch athlete at that. My genetic gifts lie in the area of eye-hand coordination and street saviness. How I had a father who was a world-class swimmer and I swim like a crustacean is beyond me. Any modicum of success that I have had in the past has been due to drive, determination, strategy and the sheer willingness to outlast anyone believing and proving that I can endure a greater level of pain than most.

Therein lies the rub. All of this depends upon serene focus, and quite frankly my focus right now is on our cat, laying in a glass submarine in intensive care on the upper east side with his celebrity cardiologist. On the other hand, I can say that I’ve never felt better than I do tonight about his prognosis but I’d still rather be with him than on a bike or on a treadmill doing something that quite frankly seems to be pretty self indulgent.

So how then do I regain focus, and what exactly am I focusing on. It’s the classic black box scenario. I know I have to perform two time trials tomorrow, and then suck up to the judges who are indeed humans. How they make their decision is anyone’s guess and quite frankly the criteria hasn’t been very well articulated. Hey if they’re looking for an over 40, fast-twitch coach who spends his time being sarcastic and hopefully helping adults and kids to pursue their lives more effectively, then I’m your guy. You notice nowhere in there did I say “athlete”. Oh yes, there was a time many years ago, when I thought I was the shit. I strutted around Los Angeles with guys who’s names you would immediately recognize for their athletic accomplishments. And, yes, I was one of THOSE guys. But that was a loooooong time ago. Heck, we have team members who weren’t even borne when we were terrorizing the courts at Pauley Pavilion, Venice, Adams, and Beverly High. But here I am, saying “Sometimes you just have to say What the FU$% and take some chances.” to quote Tom Cruise in what was his first and best role as an actor. But that was before all of this happened to Wally.

So then, how does one perform when performance requires focus and one’s focus is clearly elsewhere. Well to begin, it requires acceptance that my focus has indeed shifted. Instead of fighting it and viewing that shift as a weakness or sign of failure, accept it first and foremost. Second, figure out if there is anything or anywhere you should be to be more productive around that core issue. In this case, at 11:45am tomorrow morning, not really. Lastly, make your distraction your focus. I know that my strength is in enduring. I’m sure others out there have similar abilities to do this, but knowing what Wally has endured himself has now become my strength, and they simply don’t have that. Seeing Wally with a catheter stick out of the top of his neck, and witnessing every labored breath he takes, I am embarrassed to think that somehow 35 minutes of exercise could be considered endurance. Endurance is what Wally has been going through each and every minute of everyday since this began. Thinking that comfort is an entitlement is both selfish and ignorant. Not once through this entire process did Wally ever complain, ever feel sorry for himself or ever think “Why is this happening to me?” And, yet, that reaction is so common place in the generation of people of whom I am a part. It seems to be even worse with the GenY’s and the Millennials.

So tomorrow, I will ride and I will run and I will do what is expected of me regardless of conditions or circumstances. And if I become complacent in my determination, I will recognize it for what it is, an aberration. And I will focus on Wally knowing that the sooner I finish, the sooner I can get out of there to spend time on the true priorities. Sucking up to judges won’t be one of them.

Endurance: The Wally Watch (Part 2)

Friday morning and a lot has transpired. First let me begin by starting with the fact that he’s still alive, which is a good thing. He’s still battling for his life and still has a long way to go and as always, when you get one thing under control, you’re bound to find something else. Sort of like trying to stop a flood with cheese cloth.

Wednesday:

Here’s Wally in ICU sticking his head out of his oxygen tent portal. He’s so small for a cat whose nickname used to be “Bruiser”.

Wally in his oxygen tent/submarine with portal

Wally with one of his doctors. Notice how many wires are coming out of Wally’s paws and neck. Ouch!

Wally with one of his young doctors

Wally has a catheter stuck into his jugular and more pin holes than a cushion. Still he’s blood doping and taking in enhanced oxygen so he’s looking pretty good. Welcome to the BALCO veterinarian hospital.

Wally doing better on “The Juice”

Wednesday night, Dr. Fox said that they had removed fluid from his lungs but that they couldn’t get it under control. He’s on thyroid medicine but no serious changes one way or the other.

Thursday:

We felt pretty good after seeing Wally on Wednesday walking around in his glass house, and Thursday he was taken off of his monitoring EKG and off the juice. At his highest, Wally’s heart rate was 260 beats per minute and Dr. Fox was very concerned that his heart would just stop. By Thursday his heart rate was down to 160, which was clearly a positive sign. Cindy went to see Wally first and she called me and told me that he didn’t look very good. I told her it was probably because he was out of his oxygen environment and the fact that he was breathing on his own was a good sign. I went to see him later in the afternoon. He was really beat up.

Wally looking tired and beat up

I have to think part of this is that he’s just been through a war. Forget Ironman, this kitty has endured a whole heck of a lot more than we ever will. His paws still show the effects of the EKG leads that he wore for two days when he was severely tachacardic. That’s the worst road rash I’ve seen in awhile.

Wally’s bloody paws

Bottom line, he’s just tired. I spent about 45 minutes with him just laying in my lap. His catheter is still in his neck and that can’t feel good. He looks so sad. He moved his head around a bit but he really couldn’t walk more than a few steps before falling back down again. He’s both fatigued and still fairly anemic. Dr Fox also told us that he has fluid in his heart and a small mass near the bottom of his heart that they aren’t sure about. Wally will have another echo on Friday morning and we’ll know more then.

Wally post-treatment

Hopefully today will be a better day. Can’t wait to go see him.

The attributes of a performance culture, or patient-centric healthcare through Wally's crossed eyes.

Cross-eyed Wally

The identification of talented individuals isn’t hard. It’s most easily measured directly through observation. In business or athletics, you can start by looking at past performance. But what if you have no past performance to go off of? What if all you have is word of mouth, initial reactions, or perhaps the briefest of interactions during which you need to make an assessment of a person or an organization’s performance? And what if your decision was one that made the difference between life and death?

This past week has been challenging for Cindy and me as our cat Wally was stricken with a host of symptoms, all of which led us to seek medical attention from our regular local area veterinarians. To give you a little background, Wally is a Russian Blue, he’s 16 years old, was a rescue and is cross-eyed which has always made him more than a little crazy. He’s also what I call “clingy and needy with low self esteem”, meaning that he always wants to be on you, purring, drooling or vying for your attention. Of course at any time this cat may suddenly scratch you or bite you while doing the rabbit-kick thing that cats use to eviscerate their prey. Cindy’s mom had her Achilles tendon severed by this lovable animal a few years back. Oh did I tell you that at his prime this cat weighed in at twenty pounds?

Wally lost weight when we moved to New York because I put him on a strict nutritional plan and gave him and his sister/lover/whatever she is female cat “Little Girl” the basement as their room, which means to visit us, he has to do stairs multiple times a day. Suffice it to say that this past summer Wally would have made the cover of the Cat Fancy Under Armor catalog.

Over the past few weeks, however, he started to drop weight significantly and when we finally took him in to get checked, we chose to take him to our local vet in Scarsdale. Now Scarsdale is sort of a hoity-toity village in Westchester County with families with lots of pets and the income to support them in the lifestyles to which they have become accustomed.

Friday morning

Cindy took Wally in and called me up at work with an “It’s bad; Wally is very sick.” message. Wally weighed only seven pounds and was basically a walking skeleton. The doctor took x-rays and said that he had either a mass in front of his heart or his lungs were completely filled with fluids. Either way, they couldn’t tap him until they found out and most likely Wally wouldn’t survive the night. They provided Cindy with the phone number of a crematorium that would pick Wally up at our house when the time came.

He went on lasix for the fluid and an antibiotic. Saturday rolled around, then Sunday rolled around and while he was lethargic, he was still jumping onto the bed, still doing his stairs, still eating Little Girl’s food and still swiping at us on occasion for no apparent reason. We thought if nothing else, the quality of his life had improved. Things were looking up. On Monday we called the vet and he scheduled an echocardiogram for Tuesday at the same animal hospital.

Monday night

Wally’s condition deteriorated dramatically. He would lay around listlessly and his breathing was very labored. He became cyanotic and his gums turned blue indicating that he wasn’t taking in enough oxygen. Cindy and I at 9:30pm had to decide what to do. Relying on the vet’s advice, we figured that the mass was pressing against his heart and this was creating complications and not allowing him to breath properly. This might well be his last night. If we take him to emergency, what would they do with him? They couldn’t do surgery, according to the regular vet. So what would we be trying to do? Was it better to continue to fight or at least allow Wally’s last night to be with the warmth and familiarity of his family? Or was it better to at least take him in in the hope that they might at least make him more comfortable? We figured that they might be able to put him on oxygen to help him breath and then perhaps he would be strong enough to do the echo as scheduled. So off we went to the Emergency Room with our cat. We were quickly brought in to see the ER vet, a Dr. Chun. Now this is where I get back to judging competency or talent. Dr. Chun examined Wally and repeated the diagnosis of our vet. She didn’t have the x-rays, but said that his diagnosis made sense so that should essentially be that. She put Wally in a oxygen tent, which is more like an aquarium. We watched Wally in this fiberglass enclosure struggling to breathe, knowing that the oxygen would give him the best opportunity to do so, but also fearful that Wally’s last minutes or hours would be spent in this cold and unfeeling environment. Dr. Chun told us that they had other animals to work on so we had to leave.

Cindy and I remained in the waiting room and one of the nurses came out to tell us that there would be no more visiting opportunities tonight. Given that we weren’t sure that this would be Wally’s last night, I wasn’t too thrilled with that assessment, and so I told Cindy that we would stay in the waiting area, and presumably at some point, no more sick animals would be coming in and we could go back in to see Wally. Dr. Chun was really annoyed by our stubbornness. Basically, I figured that the years in her job must have desensitized her to the bonds that are created between family members two and four legged varieties alike. So we waited and we waited and we saw animal after animal get brought in and get treated. Finally one of the nurses, I think inspired by our dedication, came out and said we could poke our heads in for a minute. Wally was laying on his side, not moving, and staring at me. I placed my head near to his separated by the glass and a tear dripped from his eye. I know that he tears regularly but it seemed this was essentially the only emotion he could muster in his condition. I stared at his chest and saw that the tachycardia had diminished somewhat and his breathing was more regular but still strained. I was certain, if we took him home with us, he would have passed away under great discomfort or pain. Dr. Chun explained: “There’s nothing else we can do until you get the ultrasound done on him tomorrow.”

Now here begins the interesting case study on veterinary service in Westchester County. In Westchester County, most of the animal hospitals, I have discovered through this process, do not have their own ultrasound machines, so there are two, count them two doctors who are board certified to do the ultrasounds, one in Westchester and one on Long Island. They drive around from animal hospital to animal hospital on their own schedule performing this specialty service. Given that my cat appeared to be on death’s door I asked if we could call this guy. “Oh no, he’d never come out this late.” So I scratched my head and said, “Okay, well how can we guarantee that he’ll be at our regular veterinarian in the morning?” “Well you can’t.” “Can you call him and ask?” “No it doesn’t work like that.” “Why not?” “Well, because he travels around and the timing depends upon how many he has to do at the various other hospital he goes to before he gets to yours. Yours might be the first or it might be the last.” “So if no one knows, let’s call him an entice him to come to my hospital first.” “Sorry, it doesn’t work like that.” “Great. So I’m supposed to hope that my cat makes it through the night in an oxygen aquarium and then hope that this traveling doctor will get to my hospital in time to do his thing so we can finally begin to treat the poor animal who hasn’t by the way had food or water since midnight in the off chance that my hospital might be first on his milk route?” “Sorry.” “You could drive down to Manhattan to Animal Medical Center; they have everything over there, including cardiologists on staff. But they might not have the cardiologist there tonight even if they have someone to do the ultrasound.” “Well can we call over there?” “Sorry, they turn their switchboard off at night, and if they aren’t there you’ll have to transport an already weakened cat back up here and he might not make it.”

I’m getting pretty frustrated by now and don’t want to cause anymore stress to Wally tonight, so I decide to play the odds, leave him in his oxygen aquarium for the night and transport him on oxygen to our regular vet in the morning to meet with the traveling ultrasound guy. I place my USC sweatshirt into his aquarium so at least he has something familiar around him to lay on. Oh by the way, the bill for the oxygen aquarium for the night? $640. “We’ll be back at 7:30am to take him over to our vet”, Cindy says to the nurse. “No don’t come until eight o’clock because you don’t want to take Wally off of oxygen until you know that your vet is open and they don’t open until 8:00 am.” We were kicked out of the waiting room at 1:30am.

Tuesday morning

A few hours later, we were back in the car arriving back at the emergency center at 8:00 am, sharp. Dr. Chun walks out and before telling us about the status of our cat, whether he was alive or dead, she blurts out “You’re late!” Cindy who cried most of the night had now had enough and ripped into her. Not only were we told not to come at 7:30 am by the nurse, this doctor’s bed-side manner plained sucked! At what point does the magic of helping to save lives turn into just a job, something one does to pay the bills, so you can buy groceries or a new Porsche? This concept fascinated me in some twisted way. This vet knew how upset we were and her first action was to lash out at us – unbelievable.

So here we are driving on the Bronx River Parkway with a four foot tall oxygen tank on rollers and a cat inside a container sealed except for a small hole for the oxygen tube. We arrive at the Scarsdale Animal Hospital at 8:30am. We take Wally inside and tell them that this is a carrier with a limited supply of oxygen, he is scheduled for an ultrasound, please take Wally and put him onto their oxygen system and may we speak with the doctor? They don’t want to take Wally out of that container, the vet doesn’t show up until between 9:30 am and 10:00 am and I can’t really tell you when the ultrasound guy will be here, and oh by the way, he’s not a doctor. The ultrasound guy is a technician, and the charts will still need to be looked at by a doctor. Those results won’t be back until tomorrow. I am furious at this point. Has anyone noticed that we have a cat in critical condition, and supposedly your job is to provide care to cats so that his health might improve using technological advances that have occurred sometime after George Washington made his wooden teeth?

I finally blurt out, “I don’t care about any of your administrative issues or policies that you have set up, I want my cat to receive the best treatment available, how do I do this?” “As soon as the doctor gets here, he can give you that information.” Sheepishly, I sit down and count the minutes. Just as a Plan-B, I call the Animal Medical Center in Manhattan and am surprised when a human being answers the phone, and then further surprised when she shows some level of compassion , urgency and professionalism. I make an appointment with a cardiologist at 11:30 am, and yes they can do the echo and yes he can look at the results immediately and treat the cat’s situation.

The vet finally decides to show up at work and he says: “Well he looks much like he did on Friday.” “If you do the ultrasound here, we won’t get the results until tomorrow and he might not make it through the night.” “OK, so where else can we go that has not only an ultrasound but a qualified vet to read it and provide treatment?” The vet then tells me that there is a great cardiologist in Katonah, about 40 minutes north of Scarsdale but potentially quicker than going to Manhattan, since we’ll have to transport Wally on whatever oxygen is left in the tank, because these people wouldn’t put Wally into their oxygen system. So the receptionist calls the Katonah Animal Hospital and they page the cardiologist because apparently he also doesn’t keep regular office hours. I look at my watch and it is now 9:45 am. I know it will take at least an hour to drive to Manhattan so I agree to wait 30 minutes for this cardiologist to call our vet back. Tick tock, tick, tock. Finally, the cardiologist calls back and our vet says he can’t see you until 3:00 pm today.

I immediately tell the vet to prepare Wally for transport, and holler out to Cindy, “Let’s go, we’re going to Manhattan.” We wheel the $250 oxygen canister (reading low) and Wally’s makeshift oxygen container back out to the car and begin driving into Manhattan.

We arrive at 62nd and York at 11:15 am. The oxygen ran out completely during the drive and now Wally is out of the container because the container was sealed. No oxygen means no breathing and I didn’t want the cat to die of suffocation on the FDR heading down through Manhattan. I pull our car up onto the sidewalk across the street and Cindy jumps out and takes Wally into the building while I find a place to park.

I make my way on foot over to the Animal Medical Center and as soon as I walk up to the door, immediately, I sense something is different. There are etchings of dogs, rabbits and cats on the glass doors. There are ramps for animals to make their way up to the 2nd floor reception area and not known to me, there was emergency drop off and parking just for the hospital as well. At the reception area, I find Cindy and she tells me that upon arriving, they called out a code and no less than four doctors ran out and whisked Wally away into the hallways of this hospital. One immediately came back out and explained exactly what they were doing and when they would get back. He came back out as promised and explained that they were optimistic, that he seemed to be stable and they would tend to him immediately. The waiting room was filled with people and their animals. While we were waiting, doctors came out one after the other to speak with the people in the waiting area, some with smiles, all with positive attitudes and compassion, and all as professional and as caring as could be. It was then that I realized what was going on. This was a teaching hospital for animals. Well, not for teaching animals but for veterinarians. These interns and residents scurrying around still believed that they were making a difference, that they were in the business of saving lives, not trying to put their kids through Scarsdale schools. Their purpose was to enhance the quality of life at every opportunity while never forgetting that their four-legged or talon-laden patients were no less important than the patients a few blocks down at Weil Cornell Medical Center at NY Presbyterian Hospital.

We waited for a long time, but never felt like Wally was just sitting in some cold dark room waiting to be tended to or to die. These people in their actions, attitude, demeanor and professionalism instilled a confidence that we had been sorely lacking. When Dr. Fox came out to talk to us, he reviewed everything that had been done and discussed what they were going to do. Already he had removed about 50% of the fluid from Wally’s lungs (our vet said they couldn’t do that), he had tranquilized him to calm him down and they had him on oxygen with an IV to help balance out the electrolytes, which was tricky because of the collecting fluids, but absolutely necessary given his current condition. He assured us that in ICU, there was a doctor watching over him and his stats. Dr. Fox said, he would do the echocardiogram on him and be back out to tell us what he found.

The waiting

It was about an hour before Dr. Fox came back out. During that time we socialized with the other people waiting, all of which had family members inside for one reason or another. Over the loud speaker, we would hear “Dermatology line 403, or Orthopedics, line 502.” This place was amazing. They treated large animals, small animals; they had cardiologists and orthopedists and oncologists and ophthalmologists and every kind of specialist you could imagine. The little Yorkie next to us was having a consultation to have his anterior cruciate ligament surgically repaired. Toxicologists were discussing options and treatments with a man who’s Chow had swallowed rat poison. To everyone in this building, which was multiple stories high, these were patients and their job was to improve the health of their patients. When a dog came in who’s tongue was blue, all of the doctors in the waiting room with patients, jumped up and ran to help this critically ill patient. These people love what they do. This is not something that one can fake – not that well. So what was it about this place and its culture that promoted that attitude consistently throughout all of their employees? Why were the animal hospitals in Westchester so substandard in both their treatment and their demeanor in comparison? I thought about that while we waited.

When Dr. Fox did return, he explained that he believed that Wally has a hyperactive thyroid which accounts for the ravenous appetite and yet the dramatic loss of weight. He doesn’t believe that the mass that is developing is cancerous but the hyperactive thyroid is most probably also responsible for the fluid in the lungs, the tachycardia and the anemia. He told us that Wally had been through a lot and a lot of damage had been done. He described our options and the possible course of treatment. He balanced the fact that Wally was 16 years old with the confidence that regardless of Wally’s age, he wasn’t yet done with his full and happy life. This isn’t to say that Wally wasn’t still in critical condition. But he felt that if we could get Wally past this hump with medications to reduce the thyroid, we could then discuss next steps. This was the same animal that our vet was ready to euthanize on Friday and again this morning.

Dr. Fox, through his actions, through his respect for Wally, through his genuine understanding for how much Wally means to us, through his patience and through his clear and concise explanation of the issues and the possible courses of action gained our confidence that Wally would be receiving the best treatment available. We agreed upon a course of action that made Wally a temporary resident of the ICU at Animal Medical Center. We were told that we could visit him between the hours of 3 pm and 7 pm and they would probably keep him for the next three to four days as they balanced the thyroid medication with the medication and treatments to continue to reduce the fluids in his lungs. When we went to visit Wally, he was among other animals in large glass oxygen containers and he had an IV in his arm and a heart rate clip on his paw to monitor his vitals. As I placed my head near to the glass, he took a swipe at me, which I took for a good sign. He has a long way to go, and anything can happen, good or bad, but at least I feel that he is with people that genuinely care about the outcome and impact of their work, and care about all of their patients, two and four legged alike. Animal Medical Center is an establishment that I would recommend to anyone that will listen. What they have created there is amazing and unique. But it doesn’t have to be.